Insemination – indications, methods and efficiency

The insemination is one of the most long standing therapeutical methods. Its efficiency depends on apparent or hidden female factor, stimulation protocol, seminal parameters and determination of patient as well as physician. The best results might be achieved in patients before their thirties. The efficacy is about 8% per cycle and 32% per treatment depending on indications. The insemination is of evident value only in cases of donor semen, sexual factor and moderate male subfertility. Ovarian stimulation improves results of insemination probably thanks to major count of ripe follicles. Cycle monitoring by serial LH assay to state the proper moment of insemination is the best method in natural cycles. Ultrasonographic monitoring is necessary in the stimulated cycles requiring administration of chorionic gonadotrophin. The recommended seminological minimum for insemination is 1.000.000 of motile spermatozoa of 4% normal morphology according to the strict criteria. As nowadays only frozen and prepared sperm is applied the intrauterine insemination is recommended. Multiple insemination during one cycle does not ameliorate the results and repeating it more than 6-7 cycles is not advisable. In case of the lack of pregnancy the more advanced assisted reproduction techniques might be usefull.